Provider Demographics
NPI:1962687202
Name:THIEME, ALFRED III (LAC, DIPL AC)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:THIEME
Suffix:III
Gender:M
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4225
Mailing Address - Country:US
Mailing Address - Phone:503-481-0283
Mailing Address - Fax:503-536-6590
Practice Address - Street 1:1417 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4225
Practice Address - Country:US
Practice Address - Phone:503-481-0283
Practice Address - Fax:503-536-6590
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist